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Loss of Resistance: A Randomized Controlled Trial Assessing 4 Low-fidelity Epidural Puncture Simulators

Pedersen, T.H.; Meuli, J.; Plazikowski, E.J.; Buttenberg, M.; Kleine-Brueggeney, M.; Seidl, C.; Theiler, L.; Greif, R.

doi: 10.1097/01.aoa.0000542353.48835.d6
Mechanisms, Equipment, Hazards

(Eur J Anaesthesiol 2017;34:602–608)

Placing an epidural catheter for administration of regional anesthesia is considered to be a difficult skill for anesthesia residents to master. In one study, first-year residents had only an 80% success rate after 90 attempts at epidural catheter placement. With such a steep learning curve, it would be beneficial to have significant simulated experiences before performing the procedure on patients. Several simulators are commercially available for practicing identification of the epidural space using a loss of resistance (LOR) technique. However, these simulators can be quite expensive, ranging in price between €1500 and 3000. The use of various fruits have been studied to simulate the feel of LOR during epidural procedures with the banana found to best simulate the sensation. In this single-blinded, randomized, controlled study the investigators compared 3 commercially available simulators and a banana for their ability to simulate the LOR feel essential to successful epidural placement.

Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland

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